Neuropathic pain describes pain that stems directly from problems with nerves. Pain from this condition can be debilitating and is very difficult to treat; it often requires a personally tailored regimen of medications. Analgesic control of neuropathic pain requires careful selection of medications, not only to maximize pain relief but to minimize side effects.
Underlying Cause
The choice of medication used to treat neuropathic pain often depends on what has caused the nerve damage, the National Institute of Neurological Disorders and Stroke explains. Some cases of neuropathic pain are caused by something pressing on the nerve, whereas others can be the result of systemic diseases such as diabetes and autoimmune diseases, which are conditions in which the immune system attacks the nerves. Patients with neuropathic pain from these causes may not need intensive treatment. Some cases of neuropathic pain, however, are genetic, which can make them more difficult to treat.
Guidelines
In many cases of neuropathic pain, complete pain relief is not possible. The kinds of analgesic compounds that are effective can vary from patient to patient, the Transverse Myelitis Association notes, so an effective treatment regimen often is discovered via trial and error. In general, new medications should be introduced one at a time and need time to become fully effective. Patients typically should start with low doses of the compound and then gradually have their dosage increased to avoid undesirable side effects. The Transverse Myelitis Association also notes that different drugs within a class of medication should be tried, even if other compounds from that pharmaceutical category have not been effective. This is because often one compound may be effective even if others do not provide adequate pain relief.
Antidepressants
Certain kinds of antidepressants have also been found to be effective for the treatment of neuropathic pain, according to a 2007 article in Pain, titled "Pharmacologic management of neuropathic pain: Evidence-based recommendations." Tricyclic antidepressants, such as amitriptyline are considered to be a first-line treatment for neuropathic pain. Many patients also benefit from a class of medications called selective serotonin and norepinephrine reuptake inhibitors, which is a type of antidepressant that includes the compound duloxetine.
Opioids
Opioid medications are powerful analgesics, the Merck Manual notes. These compounds can be used for the treatment of neuropathic pain. They are, however, less effective at treating pain that stems from nerve damage than they are at treating other kinds of pain. In addition, opioid analgesics carry with them a strong potential for addiction, particularly when they are used in high doses.
Antiepileptics
Another class of medications, called anticonvulsants or antiepileptics are also useful for treating neuropathic pain. How these medications are able to provide pain relief is not well understood, according to the Transverse Myelitis Association. These medications might work by suppressing abnormal electrical activity of neurons, which helps keep them from sending aberrant pain signals. These drugs work on the peripheral nervous system and on the brain. Antiepileptics commonly used for neuropathic pain include gabapentin, carbemazepine and phenytoin. These medications may only be effective for a specific subtype of neuropathic pain, but they can provide tremendous relief for patients in that subtype.
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